Office Evaluation Research Articles

Elevación de las enzimas de función hepática en nuestro medio: estudio etiológico y de la eficacia de una consulta de acto único

BackgroundLiver enzyme (LE) elevation is a common finding in routine blood analysis. There is very little information on the most prevalent causes of these alterations in our population. In addition, a number of tests and several visits to the specialist are required to reach a diagnosis. For these reasons, we designed a protocol to streamline the evaluation of patients with LE elevations in a single-act office visit. MethodsFrom March 2008 until June 2010, we studied all patients with incidental LE elevation (isolated transaminase elevation, combined elevation of alkaline phosphatase [FA] and gamma-glutamyl transpeptidase [GGT], or isolated elevation of GGT) who were referred by their primary care physicians. At the time of referral, a complete biochemistry analysis was performed (LE, viral serology, autoantibodies, ceruloplasmin, iron metabolism, alpha-1-antitrypsin and thyroid hormones) and the patients underwent an abdominal ultrasound scan on the day of the office evaluation by the hepatologist. ResultsA total of 427 patients were included in our study. The most common cause of transaminase elevation was non-alcoholic fatty liver disease (NAFLD) (40%), followed by alcohol intake (17%), and hepatitis C virus infection (13%). Elevated GGT levels were most commonly related to NAFLD (30%), closely followed by alcohol intake (27%), and hepatotoxicity (8%). Combined elevation of GGT and FA was associated with NAFLD (21%), alcohol (17%), and hepatotoxicity (11%). Self-limited elevation was seen in 9% of the patients and we could not identify a definite cause in 11%. A definitive diagnosis was reached in 79% of the patients. ConclusionsThe single-act office visit has proven to be efficient, yielding a diagnosis in most of the patients. The most common cause of elevated LE was NAFLD. Transaminase elevation must be confirmed before a more thorough work-up is started.

Target organ damage and masked hypertension in the general population

The relation of masked hypertension to target organ damage has very seldom been investigated in a general population. An unselected population cohort (n = 1989 of which 1540 were not treated for hypertension) underwent office (duplicate measurements on one visit by a nurse) and home (duplicate measurements on 7 days) blood pressure (BP) measurements and evaluation of electrocardiographic left ventricular hypertrophy (ECG-LVH, n = 1989/1540), carotid intima-media thickness (cIMT, n = 758/592), and pulse wave velocity (PWV, n = 237/158). ECG-LVH was diagnosed using Cornell voltage criteria. PWV was measured using whole-body impedance cardiography. Masked hypertension was defined as office BP less than 140/90 mmHg with home BP at least 135/85 mmHg and white-coat hypertension as office BP at least 140/90 mmHg and home BP less than 135/85 mmHg. Masked and sustained hypertensive individuals had significantly higher age-adjusted and sex-adjusted Cornell voltage, cIMT, and PWV than normotensive individuals. White-coat hypertensive patients had higher age-adjusted and sex-adjusted Cornell voltage than normotensive individuals but significantly lower Cornell voltage and PWV than sustained hypertensive patients. The differences in Cornell voltage and PWV remained significant after adjustment for confounding factors. However, all differences became nonsignificant after adjustment for systolic home BP. Masked and sustained hypertension is accompanied by increased risk for hypertensive target organ damage, whereas white-coat hypertension seems to be a more benign phenomenon.

Sa1919 Evaluation of a Novel Office Based 14C Urea Breath Test, Heliprobe®, in Patients Undergoing Endoscopy

Sa1919 Evaluation of a Novel Office Based 14C Urea Breath Test, Heliprobe®, in Patients Undergoing Endoscopy

Patrol officers and public reassurance: a comparative evaluation of police officers, PCSOs, ACSOs and private security guards

The objective of this study is to establish how well the public distinguishes between different uniformed patrol officer patrolling shopping malls, and whether they have different effects on feelings of safety and worry about crime. It is based on interviews with a sample of 502 shoppers at five shopping malls in Southern England. Using photographs, most respondents correctly identified the police officer and the PCSO, whereas fewer recognised the ACSO and private security guard, and few the ACSO. Police officers instilled the greatest feelings of safety, well above PCSOs, who, in turn, were rated above security guards and ACSOs. Police officers also generated the most worries, especially among young women. Police officers emit ‘control signals’ that have stronger positive effects on reassurance, reflecting correct identification combined with established regard and confidence. Patrol officers who were not police officer provided weaker ‘control signals’. Correct identification made less difference to reassurance they provided, especially for security guards. Police officers appear to be as cost-effective as PCSOs, though far less so than private security officers. Successful ‘reassurance policing’ depends on who carries out the policing as well as what is policed.

Pre‐operative urodynamics in women with stress urinary incontinence increases physician confidence, but does not improve outcomes

To determine if pre-operative urodynamic testing (UDS) affects physicians' diagnostic confidence and if physician confidence affects treatment outcomes at 1 year. The Value of Urodynamic Evaluation (ValUE) trial randomized 630 women with predominant stress urinary incontinence (SUI) to office evaluation (OE) or OE plus UDS prior to surgery. After OE, physicians completed a checklist of five clinical diagnoses: SUI, overactive bladder (OAB) wet and dry, voiding dysfunction (VD), and intrinsic sphincter deficiency (ISD), and reported their confidence in each. Responses ranged from 1 to 5 with; 1 = "not very confident (<50%)" to 5 = "extremely confident (95 + %)." After UDS, investigators again rated their confidence in these five clinical diagnoses. Logistic regression analysis correlated physician confidence in diagnosis with treatment success. Of 315 women who received OE plus UDS, 294 had complete data. Confidence improved after UDS in patients with baseline SUI (4.52-4.63, P < 0.005), OAB-wet (3.55-3.75, P < 0.001), OAB-dry (3.55-3.68 P < 0.005), VD (3.81-3.95, P < 0.005), and suspected ISD (3.63-3.92, P < 0.001). Increased confidence after UDS was not associated with higher odds of treatment success although mean changes in confidence were slightly higher for those who achieved treatment success. Physician diagnoses shifted more from not confident to confident for ISD and OAB-wet after UDS (McNemar's P-value <0.001 for both). In women undergoing UDS for predominant SUI, UDS increased physicians' confidence in their clinical diagnoses; however, this did not correlate with treatment success.

Comprehensive On-site Medical and Public Health Training for Local Medical Practitioners in a Refugee Setting

In refugee settings, local medical personnel manage a broad range of health problems but commonly lack proper skills and training, which contributes to inefficient use of resources. To fill that gap, we designed, implemented, and evaluated a curriculum for a comprehensive on-site training for medical providers. The comprehensive teaching curriculum provided ongoing on-site training for medical providers (4 physicians, 7 medical officers, 15 nurses and nurse aids, and 30 community health workers) in a sub-Saharan refugee camp. The curriculum included didactic sessions, inpatient and outpatient practice-based teaching, and case-based discussions, which included clinical topics, refugee public health, and organizational skills. The usefulness and efficacy of the training were evaluated through pretraining and posttraining tests, anonymous self-assessment surveys, focus group discussions, and direct clinical observation. Physicians had a 50% (95% CI 17%-82%; range, 25%-75%) improvement in knowledge and skills. They rated the quality and usefulness of lectures 4.75 and practice-based teaching 5.0 on a 5-point scale (1=poor to 5=excellent). Evaluation of medical officers' knowledge revealed improvements in (1) overall test scores (52% [SD 8%] to 80% [SD 5%]; P < .0001); (2) pediatric infectious diseases (44% [SD 9%] to 79% [SD 7%]; P < .001); and (3) noninfectious diseases (57% [SD 16%] to 81% [SD 10%] P < .01). Main barriers to effective learning were lack of training prioritization, time constraints, and limited ancillary support. A long-term, ongoing training curriculum for medical providers initiated by aid agencies but integrated into horizontal peer-to-peer education is feasible and effective in refugee settings. Such programs need prioritizing, practice and system-based personnel training, and a comprehensive curriculum to improve clinical decision making.

低炭素型オフィスの計画とワークプレイスの環境性能評価 （その4）空調システムの効率評価と建物全体のエネルギー評価

低炭素型オフィスの計画とワークプレイスの環境性能評価 （その4）空調システムの効率評価と建物全体のエネルギー評価

The Effect of Urodynamic Testing on Clinical Diagnosis, Treatment Plan and Outcomes in Women Undergoing Stress Urinary Incontinence Surgery

We evaluated the influence of preoperative urodynamic studies on diagnoses, global treatment plans and outcomes in women treated with surgery for uncomplicated stress predominant urinary incontinence. We performed a secondary analysis from a multicenter, randomized trial of the value of preoperative urodynamic studies. Physicians provided diagnoses before and after urodynamic studies and global treatment plans, defined as proceeding with surgery, surgery type, surgical modification and nonoperative therapy. Treatment plan changes and surgical outcomes between office evaluation and office evaluation plus urodynamic studies were compared by the McNemar test. Of 315 subjects randomized to urodynamic studies after office evaluation 294 had evaluable data. Urodynamic studies changed the office evaluation diagnoses in 167 women (56.8%), decreasing the diagnoses of overactive bladder-wet (41.6% to 25.2%, p <0.001), overactive bladder-dry (31.4% to 20.8%, p = 0.002) and intrinsic sphincter deficiency (19.4% to 12.6%, p = 0.003) but increasing the diagnosis of voiding dysfunction (2.2% to 11.9%, p <0.001). After urodynamic studies physicians canceled surgery in 4 of 294 women (1.4%), changed the incontinence procedure in 13 (4.4%) and planned to modify mid urethral sling tension (more or less obstructive) in 20 women (6.8%). Nonoperative treatment plans changed in 40 of 294 women (14%). Urodynamic study driven treatment plan changes were not associated with treatment success (OR 0.96, 95% CI 0.41, 2.25, p = 0.92) but they were associated with increased postoperative treatment for urge urinary incontinence (OR 3.23, 95% CI 1.46, 7.14, p = 0.004). Urodynamic studies significantly changed clinical diagnoses but infrequently changed the global treatment plan or influenced surgeon decision to cancel, change or modify surgical plans. Global treatment plan changes were associated with increased treatment for postoperative urgency urinary incontinence.

A Randomized Trial of Urodynamic Testing Before Stress-Incontinence Surgery

Urodynamic testing is often performed preoperatively for stress urinary incontinence. However, previous studies have not demonstrated improved surgical outcomes with such testing. No randomized controlled trials have addressed this issue. This multicenter, randomized, noninferiority trial compared outcomes at 1 year among women with uncomplicated stress urinary incontinence who underwent preoperative urodynamic testing and office evaluation before their planned surgery and those who received evaluation only. Treatment success at 12 months, the primary outcome, was defined as a reduction on the Urogenital Distress Inventory score of 70% or more and a Patient Global Impression of Improvement response of “very much better” or “much better.” A predetermined noninferiority margin of 11 percentage points was selected on the basis of clinical judgment. Of the 630 patients evaluated, 315 were randomized to office evaluation with urodynamic tests and 315 to evaluation only. Treatment was successful in 76.9% (203/ 264) of women in the urodynamic-testing group as compared with 77.2% (200/259) of those in the evaluation-only group; the between-group difference of −0.3 percentage points (95% confidence interval, −7.5 to 6.9) was consistent with noninferiority. No significant between-group differences were found for secondary measures, including incontinence severity, quality of life, patient satisfaction, rates of positive provocative stress tests, voiding dysfunction, or adverse events. Women in the urodynamic-testing group were significantly less likely to receive a diagnosis of an overactive bladder and were more likely to receive a diagnosis of voiding-phase dysfunction than those in the evaluation-only group. However, this change in preoperative diagnosis after urodynamic testing did not result in significant differences in treatment selection or outcomes. These findings indicate that routine preoperative urodynamic testing for women with uncomplicated stress urinary incontinence does not improve outcomes at 1 year over that found with in-office evaluation alone.

Office Evaluation of Male Patients with Lower Urinary Tract Symptoms

Lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) are one of the most common urologic disorders in men. Accurate history-taking and focused physical examination allows us to diagnose the majority of cases. A better understanding of risk factors helps us tailor our treatment and predict outcomes more accurately. Population studies are crucial in our understanding of LUTS/BPH natural history. Temporary prostatic urethral stents that are used for the management of urinary retention may also be used for evaluation of patients with detrusor hypo-contractility. The use of ultrasound to measure intravesical prostatic protrusion (IPP) and the Doppler study for prostate capsular artery resistive index are promising. Near-infrared spectroscopy (NIRS) examines the tissue oxygenation that may be affected by bladder outlet obstruction. The mathematical algorithm needs some fine-tuning, and its reproducibility is debatable. Serum and urinary biomarkers may help us to diagnose the disorder, and more effectively monitor patients' response to therapy. Among all, IPP is clinically more applicable at this time.

A Retrospective Comparative Study of Traction Therapy vs. No Traction Following Tunica Albuginea Plication or Partial Excision and Grafting for Peyronie's Disease: Measured Lengths and Patient Perceptions

Loss of penile length is a recognized and common consequence of Peyronie's disease (PD). Traction therapy (TT+) has been reported to decrease post-op length loss as well as increase stretched penile length (SPL) prior to surgery. The aim of this study was to study patient outcomes with penile length change and patient satisfaction after surgery following tunica albuginea plication (TAP) and partial plaque excision and grafting (PEG) with or without postoperative TT. Retrospective analysis was performed from our cohort of Peyronie's reconstructive surgery between 2007 and 2010. SPL was measured dorsally from pubis to corona and recorded at the initial office visit and then compared to most recent postoperative visit. Patients were then stratified by procedure and whether TT was used (TT+ and TT-; TAP N = 52 [27 TT+ and 25 TT-] and PEG N = 59 [36 TT+ and 23 TT-). Traction therapy was initiated for >2 hours a day for 3 months typically starting 3-4 weeks postoperatively. A non-validated mailed questionnaire assessed patient perceptions. Mean length change seen in TAP (TT+) was 0.85 cm (0.25-1.75) vs. -0.53 cm (-1.75 to 0.5) in TAP (TT-) (P < 0.001). The mean length change seen in PEG (TT+) was 1.48 cm (0-6) vs. PEG (TT-) 0.24 cm (-1 to 2.5 cm) (P < 0.001). Sixty-one percent of surveys were returned; 85% lost length prior to the initial office evaluation, with an average of -2.5 cm lost. Importantly, in those who used traction, there was no perceived length loss, 58% reported a mean erect length gain of 1.1 cm. However, only 54% of all patients were satisfied with their current erect length. Loss of length in men with PD remains a serious concern. It appears that postoperative TT can result in length preservation, and in many, a measured and perceived length gain following correction of the curvature.

G-30 低炭素型オフィスの計画とワークプレイスの環境性能評価 : (その2) ダクトレス空調システムによる夏期室内風速・温度分布測定結果

G-30 低炭素型オフィスの計画とワークプレイスの環境性能評価 : (その2) ダクトレス空調システムによる夏期室内風速・温度分布測定結果

The urethra is a reliable witness: simplifying the diagnosis of stress urinary incontinence

In 1970, Bates, Whiteside, and Turner-Warwick [1] wrote that: “...the bladder often proves to be an unreliable witness...” and this phrase has been used for more than 40 years as a justification for urodynamic studies (UDS) in the evaluation of urinary incontinence. However, two studies published this year in the New England Journal of Medicine have reported the predictive value of direct observation of fluid loss from the urethra in making the diagnosis of stress urinary incontinence (SUI) [2] and occult SUI [3]. The studies suggest that for SUI or occult SUI, appropriate management decisions can be made with an office evaluation that includes demonstrating urine loss from the urethra without additional UDS. It probably should not surprise us that SUI is not a condition that requires urodynamic testing. SUI is a urethral problem and current bladder investigations do not investigate urethral conditions very well. Valsalva leak point pressures only indirectly measure urethral pressure, and urethral pressure profilometry typically only measures urethral function at rest and not during SUI conditions. No quantitative or qualitative measure during urodynamics makes the diagnosis of urodynamic stress incontinence (USI); thus, the diagnosis of USI is still dependent on direct visualization or imaging of fluid loss per urethra with cough or Valsalva. The presence of a catheter in the bladder (UDS) adds nothing of value to the diagnosis of SUI, except that it can confirm the absence of a cough or Valsalva provoked detrusor contraction. One could argue, though, that this type of detrusor event would not produce simultaneous fluid loss with cough, because a detrusor smooth muscle is not a striated muscle and cannot contract fast enough to generate detrusor pressure at the same time as a cough. Thus, there seems to be a limited role for urodynamics for SUI in the setting of a comprehensive history, office evaluation, and examination. Unfortunately, the current medical model encourages diagnostic studies whether or not they are necessary. This editorial proposes that the diagnosis of uncomplicated SUI and occult SUI by an office stress test and the management of it does not require urodynamic testing in most patients.

A Randomized Trial of Urodynamic Testing before Stress-Incontinence Surgery

BackgroundUrodynamic studies are commonly performed in women before surgery for stress urinary incontinence, but there is no good evidence that they improve outcomes.MethodsWe performed a multicenter, randomized, noninferiority trial involving women with uncomplicated, demonstrable stress urinary incontinence to compare outcomes after preoperative office evaluation and urodynamic tests or evaluation only. The primary outcome was treatment success at 12 months, defined as a reduction in the score on the Urogenital Distress Inventory of 70% or more and a response of “much better” or “very much better” on the Patient Global Impression of Improvement. The predetermined noninferiority margin was 11 percentage points.ResultsA total of 630 women were randomly assigned to undergo office evaluation with urodynamic tests or evaluation only (315 per group); the proportion in whom treatment was successful was 76.9% in the urodynamic-testing group versus 77.2% in the evaluation-only group (difference, −0.3 percentage points; 95% confidence interval, −7.5 to 6.9), which was consistent with noninferiority. There were no significant between-group differences in secondary measures of incontinence severity, quality of life, patient satisfaction, rates of positive provocative stress tests, voiding dysfunction, or adverse events. Women who underwent urodynamic tests were significantly less likely to receive a diagnosis of overactive bladder and more likely to receive a diagnosis of voiding-phase dysfunction, but these changes did not lead to significant between-group differences in treatment selection or outcomes.ConclusionsFor women with uncomplicated, demonstrable stress urinary incontinence, preoperative office evaluation alone was not inferior to evaluation with urodynamic testing for outcomes at 1 year. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and the Eunice Kennedy Shriver National Institute of Child Health and Human Development; ClinicalTrials.gov number, NCT00803959.)

Hi-Fi Simulation—Rehearsing for Success

Hi-Fi Simulation—Rehearsing for Success

Acoustic evaluation and adjustment of an open-plan office through architectural design and noise control

Arranging office space into a single open room offers advantages in terms of easy exchange of information and interaction among coworkers, but reduces privacy and acoustic comfort. Thus, the purpose of this work was to evaluate the acoustic quality of a real open-plan office and to propose changes in the room to improve the acoustic conditioning of this office. The computational model of the office under study was calibrated based on RT and STI measurements. Predictions were made of the RT and STI, which generated the radius of distraction rD, and the rate of spatial decay of sound pressure levels per distance doubling DL2 in the real conditions of the office and after modifications of the room. The insertion of dividers between work stations and an increase in the ceiling’s sound absorption improved the acoustic conditions in the office under study.

1186 FINAL OFFICE EVALUATION FINDINGS IN E-SISTER PARTICIPANTS AT ONE CENTER: A GLIMPSE INTO THE LONG-TERM RESULTS OF STRESS INCONTINENCE SURGERY

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy II1 Apr 20121186 FINAL OFFICE EVALUATION FINDINGS IN E-SISTER PARTICIPANTS AT ONE CENTER: A GLIMPSE INTO THE LONG-TERM RESULTS OF STRESS INCONTINENCE SURGERY Philippe Zimmern, Hong Zhao, Tamara Dickinson, Xian-Jin Xie, and Gary Lemack Philippe ZimmernPhilippe Zimmern Dallas, TX More articles by this author , Hong ZhaoHong Zhao Dallas, TX More articles by this author , Tamara DickinsonTamara Dickinson Dallas, TX More articles by this author , Xian-Jin XieXian-Jin Xie Dallas, TX More articles by this author , and Gary LemackGary Lemack Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1431AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Because of attrition rate in long-term surgical incontinence studies, most available data are derived from phone interviews or postal questionnaires. We report on an ancillary study of E-SISTER participants at one center who returned for long-term office evaluation. METHODS Following IRB and UITN approval, participants in E-SISTER at one center were invited to return for an extensive final office evaluation, including validated questionnaires, physical examination (with POP-Q), cough stress test, and a non-invasive flow rate. The intent of this visit was to explore the rate of recurrent urethral hypermobility, secondary prolapse, voiding changes over time, patient satisfaction. All visits were conducted by an expert examiner unaware of patient original surgical assignment. A mixed model analysis was used to compare baseline, 2 year (end of SISTER trial), and last visit/evaluation datasets between the 2 groups. RESULTS Of 31 patients, 27 returned for a final assessment, including 12 Burch (B) and 15 Fascia sling (S). Median follow-up was 7.2 years. Using strict 5 SISTER criteria, success rate was 25% for Burch and 40% for Sling (p=0.68). Over 85 % of patients had a negative stress test. Reduction in incontinence episodes was high compared to baseline (p=0.009). Point Aa, a surrogate marker for bladder neck and proximal urethral support, improved in both groups after surgery, but did not change over time for the B group while it kept improving for S, possibly from retraction and scarring effect. No significant changes were observed for all other POPQ points over time. Mean PdetQmax was unchanged in the B group but significantly higher in the S group at 2 years (baseline18,5 cm H2O versus 32,1 cm H2O). Mean maximum flow rate dropped considerably in the S group over time (baseline 29, to 16.7 ml/sec at last visit), but remained unchanged in the Burch group. PVR remained low in both groups. 100% recommended the surgery to a friend or would have the surgery done again. QoL scores went down significantly at 2 years and trended upward at last evaluation, although much lower than at baseline. CONCLUSIONS We found stable urethral support, no secondary prolapses, concerning changes in flow parameters in the sling group over time, and a high level of satisfaction despite a notable failure rate based on very strict SISTER outcome criteria. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byKuprasertkul A, Christie A, Lemack G and Zimmern P (2019) Long-Term Results of Burch and Autologous Sling Procedures for Stress Urinary Incontinence in E-SISTEr Participants at 1 SiteJournal of Urology, VOL. 202, NO. 6, (1224-1229), Online publication date: 1-Dec-2019. Volume 187Issue 4SApril 2012Page: e480-e481 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Philippe Zimmern Dallas, TX More articles by this author Hong Zhao Dallas, TX More articles by this author Tamara Dickinson Dallas, TX More articles by this author Xian-Jin Xie Dallas, TX More articles by this author Gary Lemack Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

IEG's Role in Evaluating Climate Financing—Response

Heider asserts the importance of avoiding bias or conflict of interest in evaluating the impacts of climate change financing. We could not agree more. Independent and transparent auditing of the Green Climate Fund (GCF) and other climate change financing is not only critical to minimizing waste, but also to building the public and political will necessary to provide financial support to the developing world. We recognize that internal auditing bodies such as the Independent Evaluation Group (IEG) of the World Bank Group try to maintain independent governance structures and implement institutional mechanisms aimed at minimizing bias in project evaluation. Unfortunately, there is substantial evidence that historical and on going ties between an auditor and the aid institution create the potential for both actual and perceived bias in project evaluation. Maintaining independence and credibility is a challenge for independent evaluation offices because of shared culture and personnel. There is a revolving door between international development institutions and their internal evaluation groups ([ 1 ][1]–[ 3 ][2]). For example, a majority of the current upper management (directors, managers, program leaders, and advisers) at the IEG are former World Bank employees, in some cases for decades. The IEG itself is housed within the World Bank headquarters. It is unlikely that evaluators with long-term ties to the aid institution can conduct investigations free from concern about potential repercussions on a future career in the institution ([ 1 ][1]). Even if the evaluators are independent, the culture of the institution still affects their outlook and their methods. An external review of the Internal Evaluation Office of the International Monetary Fund (IMF) found that evaluators were often unable to think outside the box due to the influence of IMF culture and recommended that outsiders be recruited to bring fresh personalities, perspectives, and questioning attitudes ([ 1 ][1]). It is for these cultural reasons that there have been calls for evaluations of aid institutions to be conducted by people without ties to the institutions ([ 3 ][2]–[ 5 ][3]). In the case of climate change financing, the perception of the trustees and the auditing process could influence whether donor nations meet funding pledges and whether recipient nations trust financing programs. Regardless of recent initiatives to increase aid effectiveness and introduce a culture of learning to aid institutions, the perception of a conflict of interest between the auditor and the aid institution would remain. As Heider notes, this problem would not be solved by delegating evaluation to a single outside entity that could become financially dependent on the institutions it was meant to monitor. These actual and perceived conflicts of interest can be minimized by engaging a loose, third-party network of auditors through an academic-style peer review system. The internal evaluation divisions at the development banks and aid agencies would still be key players in such a system. For example, if the World Bank becomes the GCF trustee, the IEG could play a more editorial role that includes collecting project data, coordinating the external evaluation process, and reporting results of that process to the GCF Board. This approach would take advantage of the strengths of the IEG while providing the type of transparent auditing necessary to build the political and public confidence in the climate change financing system. 1. [↵][4] 1. K. Lissakers, 2. I. Husain, 3. N. Woods , Report of the External Evaluation of the Independent Evaluation Office (International Monetary Fund, Washington, DC, 2006). 2. 1. C. Weaver , Rev. Int. Org. 5, 365 (2010). [OpenUrl][5][CrossRef][6] 3. [↵][7] 1. A. Lerrick , “Is the World Bank's word good enough?,” Testimony before the U.S. Senate Foreign Relations Committee, Hearing on Multilateral Development Banks (U.S. Government Printing Office, Washington, DC, 2006). 4. 1. R. Levine , “Evaluating development aid effectiveness,” Testimony before the U.S. Senate Foreign Relations Committee, Hearing on Multilateral Development Banks (U.S. Government Printing Office, Washington, DC, 2006). 5. [↵][8] 1. W. Easterly , “Accountability for multilateral development banks,” Testimony before the U.S. Senate Foreign Relations Committee, Hearing on Multilateral Development Banks (U.S. Government Printing Office, Washington, DC, 2006). [1]: #ref-1 [2]: #ref-3 [3]: #ref-5 [4]: #xref-ref-1-1 View reference 1 in text [5]: {openurl}?query=rft.jtitle%253DRev.%2BInt.%2BOrg.%26rft.volume%253D5%26rft.spage%253D365%26rft_id%253Dinfo%253Adoi%252F10.1007%252Fs11558-010-9094-1%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [6]: /lookup/external-ref?access_num=10.1007/s11558-010-9094-1&link_type=DOI [7]: #xref-ref-3-1 View reference 3 in text [8]: #xref-ref-5-1 View reference 5 in text

178 Final office evaluation findings in E-SISTER participants at one center: A glimpse into the long-term results of stress incontinence surgery

178 Final office evaluation findings in E-SISTER participants at one center: A glimpse into the long-term results of stress incontinence surgery

Plasma Half-life Extension of Small Recombinant Antibodies by Fusion to Immunoglobulin-binding Domains

Many therapeutic proteins possessing a small size are rapidly cleared from circulation. Half-life extension strategies have therefore become increasingly important to improve the pharmacokinetic and pharmacodynamic properties of protein therapeutics. Here, we performed a comparative analysis of the half-life extension properties of various bacterial immunoglobulin-binding domains (IgBDs) derived from Staphylococcus protein A (SpA), Streptococcus protein G (SpG), and Finegoldia (formerly Peptostreptococcus) protein L (PpL). These domains, composed of 50-60 amino acid residues, were fused to the C terminus of a single-chain Fv and a bispecific single-chain diabody, respectively. All fusion proteins were produced in mammalian cells and retained their antigen-binding properties. The half-lives of the antibody molecules were prolonged to varying extents for the different IgBDs. The strongest effects in mice were observed for domain C3 of SpG (SpG(C3)) followed by domains B and D of SpA, suggesting that SpG(C3) is particularly useful to extend the plasma half-life of small proteins.